When my wife wants to get me to exercise she says “your health is your greatest wealth”. The quote is attributed to Virgil, and hence is some 2000+ years old. One would never think many people heard that quote looking at the United States today! To me, the 1948 WHO definition of health,

“Health is a state of complete physical, mental and social well-being, and not merely the absence of disease or infirmity”,

sounds like an idealist fairytale, that nobody really cares about. We all thought that health care would feature prominently in the presidential race, that is until our other wealth, the financial one, evaporated. Quickly, billions of dollars were mobilized to help out institutions, many of which I am sure still pay handsome bonuses, and it was explained to us that we could not let too many banks and insurance companies fail, because it would have worldwide, catastrophic implications. I am not knowledgeable enough to judge what would have happened, but the fact that no one in the treasury thought it necessary to see what was being done wit the money makes me a little suspicious we were – at least partially – duped.

Health care, while still mentioned, somehow took the backseat. And now of course that our federal deficit is going sky rocket, even Obama is thinking how much money Medicare and Medicaid really need. Meanwhile, at least in Maine, hospitals have not been fully paid for their services to Medicaid patients in years, and payments are delayed. As states head towards significantly depleted coffers, this will undoubtedly get worse.

Ask a (wo)man on the angered Main Street, and they wil tell you that Universal Healthcare is a good thing. Ask them if they’d pay for it (other than their own), and they’ll probably tell you “No way!”. However after some relatively minor scoffs in congress, unbelievable amounts of money have been dedicated to “save” our financial system (and way of living). Just to visualize, 700 Billion dollars is about equivalent to the annual income of 15 Million US households. It is around one third of the annual healthcare cost.

I believe this nation has to realize that its people’s health is of one of its most valuable assets and it has to act accordingly. We are developing into a nation of people ravaged by ailments such as obesity and diabetes, that may soon make (and maybe already have made) us unable to sustain our way of life as a country. Many suggestions are out there, but to me it is clear that is has to involve strengthening primary care and prevention and making health care more accessible and yes, cheaper (brace yourselves, this will mean people in the health care field will likely make less money). If we can bail out our banks, then we can find a way to bail out our people. I am quite certain that cost in the long run will be less than the cost of a nation on disability.

I have a patient with hepatitis C. She had some signs of cirrhosis (fibrosis in the liver, which is one of the effects of the virus), and she wanted to get treated, which usually requires a liver biopsy. So I referred to the liver clinic.

They sent her back to me saying that she needed an ultrasound beforehand. The ultrasound showed a possible mass, which could be liver cancer (hepatoma). In my discussions with the liver people we decided that she needed an MRI to rule out the hepatoma before moving forward with her Hep C treatment.

So like a good little monkey, I ordered her an MRI, filling out all the forms and getting all the prior approvals, kissing all the rings on all the HMO fingers.

But since it wasn’t an emergency, they gave her an MRI date five months in the future.

One week before she’s supposed to get scanned, I am contacted by the MRI techs. Why? Her ultrasound (remember that?) is now TOO OLD, so she needs to get a new ultrasound before she can get her MRI.

So okay. That would be a good end to the story: unnecessary bureaucracy causing the need for multiple imaging, the waste, etc etc.

Except that’s not the end of the story. Because of course, it’s impossible to get an ultrasound in one week, so she ends up missing the MRI appointment that it took so long to get. Now it’ll be God knows how long before she gets scheduled for another MRI. (And by the time it rolls around, the repeat ultrasound i’m getting today will be outdated. Repeatedly. Again.)

All this time, there might be a liver cancer growing in her belly.

Could a thing like this happen under another system of healthcare? Absolutely. Might a single-payer system require non-emergency MRIs to wait a few months? Of course.

So really, this story is for those who live in fear that single-payer healthcare will give us long waiting periods. Let’s be clear about it: we’ve already been given long waiting periods. The HMOs gave them to us.

But what the HMOs giveth, we can taketh away. We just have to decideth to.

There’s a great article in the last NYT of 2008 about the new “restrictions” that the pharmaceutical industry is imposing on itself. No mugs, no pens, no trinkety free goodies.

Sounds great, right? Pharma is policing itself.

Well, first of all, these restrictions are all voluntary, which means no penalty for breaking the rules. And rule-breakin’ penalties is one of the reasons we have laws.

Then if we read a little further, there’s some fine print down in grafs eleven and fourteen:

The guidelines, for example, still permit drug makers to underwrite free lunches for doctors and their staffs or to sponsor dinners for doctors at restaurants, as long as the meals are accompanied by educational presentations.

The industry code also permits drug makers to pay doctors as consultants “based on fair market value” — which critics say means that companies can continue to pay individual doctors tens of thousands of dollars or more a year.

Cutting out the pens but leaving the rest is like going on a diet where you only eat Big Macs. They’ve cut out the cheapest and least effective part of their marketing campaigns, while doing nothing about the most expensive and deviously influential elements.

Drug reps can still buy lunches for doctors in their offices; they can still take docs out to dinners, as long as there is some educational component. (I went on one of these “educational dinners” long ago… the talk lasted 5 minutes and then we ate for two hours…)

Also, the companies can still pay “consulting fees” that generally run in the tens of thousands. Some of these consultancies are real. But do you think most of the doctors who receive these consulting payments would continue to get them if those doctors banned drug reps from their offices, banned all lunches and dinners, and stopped prescribing the manufacturer’s drug?

Which leads me to my main point: drug companies should not be allowed to track in precise detail exactly which doctors are prescribing their medicines. They should be allowed to know the rough outlines — by zip code, for example — but allowing them to buy databases with the exact number of prescriptions each doctor has given out for each medicine. . . . there’s too much potential for an unspoken quid pro quo to exist between doctors and drug reps.

I am heartened by one aspect of this: the fact that Pharma is imposing these restrictions voluntarily means that they see the writing on the wall. They are trying desperately to prevent the kinds of laws that New Hampshire passed from spreading across the country. They want to give opponents of reform some ammunition, something to let them point to and say “See? The drug companies have cleaned up their act! Everything is fine now!”

Except in four or five years, when we’re paying attention to something else, the pens and mugs will come creeping back. They’ll come back slowly, a trickle at a time, without the big press release and glowing article in the New York Times.

The time has come to reject the hidden intrusion of Pharma into our lives. Prescriptions belong to doctors and patients, no one else.

(p.s. I’ve started a blog dedicated to this issue: www.prescriptionprivacy.blogspot.com)